I give my consent for the Jacksonville Urban League , Inc. Housing Counseling staff or representative to create a manual and electronic client manangement/tracking file. 

To use my personal data to aid in the advancement of its efforts to sustain and or gain funding.

To share and or receive my personal information and documents as it relates to my need for service.

To use my personal data and profile as needed and or required by funding sources.

To communicate with me regarding services via, phone, email,  or SMS text.

 

I am requesting assistance from the Jacksonville Urban League Housing Counseling Services program with the following:

Pre-Purchase Counseling
Home Maintenance
Default & Delinquency
Financial Management
Fair Housing
Supportive Services
 

 I understand that:

1.     Cooperation with the Housing Counselor, including keeping scheduled appointments and providing pertinent information and documents requested, ensures a more accurate assessment of my situation.

 2.     My signature authorizes the Housing Counselor to act on my behalf in order to address my housing and financial concerns, including, but not limited to, requesting information from outside sources such as mortgage lenders, landlords, employers, governmental agencies, etc., when necessary.

3.     I understand I am not obligated to receive any other services offered by Neighborhood Counseling Services or its partnering agencies.

 4.     Jacksonville Urban League cannot provide legal advice or representation; therefore I am responsible to obtain legal counsel should the need arise.

 5.     I will be provided with direction and information on available options based on my current situation. Any decision made in regards to these options will be made by me.

 6.     The Housing Counselor agrees to maintain strict confidentiality concerning all information pertaining to my case and to act in my best interest at all times.

 7.     My signature indicates that all information provided to the Housing Counselor is correct to the best of my knowledge, especially as it pertains to my household income.

 I/We have read and received a copy of the Conflict of Interest and Disclosure Statement Form.

Please sign and date below

1.      I understand that (JACKSONVILLE URBAN LEAGUE) provides financial capability counseling/coaching after which I will receive a written action plan consisting of recommendations for handling my finances, possibly including referrals to other agencies asappropriate.

 

2.     I understand that (JACKSONVILLE URBAN LEAGUE) submits client-level information relating to the Project Reinvest: Financial Capability grant to the NeighborWorks America Data Collection System (DCS), opens files to be reviewed for programmonitoring and compliance purposes, and conducts follow-up with clients related to program evaluation.

 3.      I understand that I may opt-out of this requirement, but proof of this opt-out must be recorded in my client file.

 4.      I give permission for the Jacksonville Urban League Housing counseling  program administrators and/or their agents to follow-up with me within the next three years for the purposes of program evaluation.

 5.      I acknowledge that I have received a copy of (JACKSONVILLE URBAN LEAGUE)'s Privacy Policy.

 6.      I may be referred to other services of the organization, another agency or agencies as appropriate that may be able to assist with particular concerns that have been identified. I understand that I amnot obligated to use any of the services offered to me.

 7.      A counselor may answer questions and provide information, but not give legal advice. If I want legal advice, I will be referred for appropriate assistance.

 8.     The (JACKSON VILLE URBAN LEAGUE) offers the following services and programs to our clients:

FINANCIAL LITERACY  COUNSELING AND EDUCATION 
 POST-PURCHASE  EDUCATION AND COUNSELING
 RENTAL EDUCATION AND COUNSELING
 PRE-PURCHASE  EDUCATION AND COUNSELING
 MORTGAGE  FORECLOSURE  PREVENTION COUNSELING AND EDUCATION
 

Financial Support for (JACKSONVILLE URBAN LEAGUE) Counseling Programs is currently being provided by the following industry partners.        National Urban League, , , City of Jacksonville, US Dept. of Housing and Urban Development (HUD) Branch Banking and Trust (BB&T), Bank of America, Wells Fargo Bank, CITI, CHASE, Fifth Third Bank.  , Regions Bank, BANK OF AMERICA.

 

 

I/We have read and received a copy of the Authorization form.Please sign and date below

 

 

The Jacksonville Urban League provides the following housing counseling services

•  FINANCIAL LITERACY  COUNSELING AND EDUCATION 
•  POST-PURCHASE  EDUCATION AND COUNSELING
•  RENTAL EDUCATION AND COUNSELING
•  PRE-PURCHASE  EDUCATION AND COUNSELING
•  MORTGAGE  FORECLOSURE  PREVENTION COUNSELING AND EDUCATION

 

I/We understand that it is my/our right and responsibility to decide whether to engage in any course of housing counseling with the Jacksonville Urban League and determine whether counseling is suitable for my/our housing issue.

I/We understand that the Jacksonville Urban League has the discretion to charge reasonable fees for some counseling and counseling related  services, and that these fees will be explained to me prior to any counseling. I further understand that fees will not be charged if they create a financial hardship and that I will not be denied counseling if I cannot pay the fee.

I/We understand that the Jacksonville Urban league provides information on a broad range of housing programs and products,  and that the Jacksonville Urban League provides  financial  literacy counseling and education,  pre-purchase education and counseling, post –purchase education and counseling,  and mortgage foreclosure prevention counseling and education through its industry partners, Financial support for the Jacksonville Urban League Counseling Programs is currently being provided by the following industry partners. National Urban League, Florida Housing Finance Corporation, Florida Housing Coalition, U.S. Dept of Housing and Urban Development  (HUD), National Foreclosure Mitigation Program, City of Jacksonville, Truist Bank, Bank of America , Wells Fargo Bank, CITI, Fifth Third Bank,

 The Jacksonville Urban League partners with banks and mortgage providers, fair housing agencies, legal service providers, insurance providers, foundations, title companies, real estate agents and/or brokerages, and credit counseling service providers. I that I am not obligated to choose any particular loan product or housing program discussed in my housing session. I/We understand that the Jacksonville Urban League does not guarantee that I/We will receive mortgage financing from and lender and /or other mortgage financing entity.

I/We may be referred to other housing services of the organization, its affiliate(s), and partners and /or to another agency or agencies as appropriate that they may be able to assist with particular concerns that have been identified. I understand that I am not obligated to use any of the services offered to me.

I/We understand that a counselor may answer questions and provide information but cannot give legal advice.

If I want legal advice I will be referred for appropriate assistance.

 

I have reviewed and understand the above Counseling Services Disclosure Statement.

 

Please sign and date below

 

 

 

 

Conflicts of interest.

(1) A director, employee, officer, contractor, or agent of a participating agency shall not engage in activities that create a real or apparent conflict of interest. Such a conflict would arise if the director, employee, officer, contractor, agent, his or her spouse, child, general partner, or organization in which he or she serves as employee (other than with the participating counseling agency), or with whom he or she is negotiating future employment, has a direct interest in the client as a landlord, broker, or creditor, or originates, has a financial interest in, services, or underwrites a mortgage on the client's property, owns or purchases a property that the client seeks to rent or purchase, or serves as a collection agent for the client's mortgage lender, landlord, or creditor.

(2)  A director, employee, officer, contractor, or agent of a participating agency shall not refer clients to mortgage lenders, brokers, builders, or real estate sales agents or brokers in which the officer, employee, director, his or her spouse, child, or general partner has a financial interest, neither may they acquire the client's property from the trustee in bankruptcy or accept a fee or any other consideration for referring a client to mortgage lenders, brokers, builders, or real estate sales agents or brokers.

(3)  A director, employee, officer, contractor, or agent of a participating agency or any member of his or her immediate family shall avoid any action that might result in, or create the appearance of, administering the housing counseling operation for personal or private gain; providing preferential treatment to any organization or person; or undertaking any action that might compromise the agency's ability to ensure compliance with the requirements of this part and to serve the best interests of its clients.

(4)  HUD may investigate agency practices and may take action to inactivate or terminate the agency's approval or participation in the Housing Counseling program.

(5)  Participating agencies must notify HUD of conflicts of interest not later than 15 calendar days after the conflict occurred and report to HUD on the corrective action taken to cure the immediate, and avoid future, conflicts.

 

 I have read and understand the Conflice of Interest Policy Statement.

Please sign and date below. 

 

To: Jacksonville Urban League

 I understand that the Jacksonville Urban League, Inc provides homebuyer education, foreclosure mitigation and financial education counseling services and rental counseling.

By signing this document, I give permission for the Jacksonville Urban League to pull my credit report.

I understand that this information is strictly confidential, and will not be shared with any parties without my permission.

This information will only be used for the purpose intended.

 

 

 

 Jacksonvile Urban League is committed to assuring the privacy of individuals and/or families who have contacted us for assistance. We realize that the concerns you bring to us are highly personal in nature. We assure you that all information shared both orally and in writing will be managed within legal and ethical considerations. Your "nonpublic personal information," such as your total debt information, income, living expenses and personal information concerning your financial circumstances, will be provided to creditors, program monitors, and others only with your authorizat ion . We may also use anonymous aggregated case file information for the purpose of evaluating our services, gathering valuable research information and designing future programs.

 

Types of information that we gather about you

• Information we receive from you orally, on applications or other forms, such as yourn ame, address, social security number, assets, andincome;
•  Information about your transactions with us, your creditors, or others, such as your account balance, payment history, parties to transactions and credit card usage; and
• Information we receive from a credit reporting agency, such as your credithistory.

You may opt-out of certain disclosures

•  You have the opportunity to "opt-out" of disclosures of your nonpublic personal information to third parties (such as your creditors), that is, direct us not to makethose disclosures.
•  You may opt-out of this requirement, but proof of your decision to opt-out must be recorded in your client file.

 

Release of your information to third parties

• So long as you have not opted-out, we may disclose some or all of the information that we collect, as described above, to your creditors or third part ies where we have determined that it would be helpful to you, would aid us in counseling/coachingyou, or is a requirement of grant awards which make our services possible
• We may also disclose any nonpublic personal information about you or formercustomers to anyone as permitted by law (e.g., if we are compelled by legalprocess.)
• Within the organization, we restrict access to nonpublic persona l information about youto those employees who need to know that information to provide services to you.
• We maintain physical, electronic and procedural safeguards that comply with federal regulations to guard your nonpublic personal information.

 

    

 

 

ACKNOWLEDGMENT AND CERTIFICATION

I hereby acknowledge that I have read and received a copy of Jacksonville Urban League's Authorization Form, Housing Counseling Agreement, Housing Counseling Disclosure Forms, Conflict of Interest, Privacy Policy, Credit Report Authorization

If you are signing up for the in-person homebuyer education class please click on the link below to pay the $75 Donation. ( IF YOU WANT TO TAKE THE ONLINE CLASS DO NOT PAY AT THIS LINK). Return the form only and a you will be provided a seperate link to pay for the online class.

Donate to the Jacksonville Urban League